Provider Demographics
NPI:1457018301
Name:VAN SICKLE, SHAWNNA TREVETTE (CNA)
Entity Type:Individual
Prefix:
First Name:SHAWNNA
Middle Name:TREVETTE
Last Name:VAN SICKLE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:SHAWNNA
Other - Middle Name:TREVETTE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25117 SW PARKWAY AVE STE D
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9697
Mailing Address - Country:US
Mailing Address - Phone:971-364-0611
Mailing Address - Fax:971-364-0610
Practice Address - Street 1:707 SW 37TH ST
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-3605
Practice Address - Country:US
Practice Address - Phone:541-276-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant